Persistent pulmonary hypertension of the newborn is the continuation or reversal of pulmonary alveolar constriction that causes a marked reduction in pulmonary flow and a right-left shunt. Symptoms and signs include tachypnea, retractions, severe cyanosis or decreased oxygen saturation, which does not respond to O2, one. Diagnosis is based on history, examination, the chest x-ray and the response to O2. The treatment includes O2, high frequency ventilation, nitrous oxide and compressors and / or inotropic agents; an extracorporeal membrane is performed when other treatments fail.

In persistent pulmonary hypertension of the newborn is a disorder of the pulmonary vessels, which affects mature or transferred children.

Persistent pulmonary hypertension of the newborn is the continuation or reversal of pulmonary alveolar constriction that causes a marked reduction in pulmonary flow and a right-left shunt. Symptoms and signs include tachypnea, retractions, severe cyanosis or decreased oxygen saturation, which does not respond to O2, one. Diagnosis is based on history, examination, the chest x-ray and the response to O2. The treatment includes O2, high frequency ventilation, nitrous oxide and compressors and / or inotropic agents; an extracorporeal membrane is performed when other treatments fail. In persistent pulmonary hypertension of the newborn is a disorder of the pulmonary vessels, which affects mature or transferred children. Etiology The most common causes are perinatal asphyxia or hypoxia A history of Mekoniumfärbung of amniotic fluid or meconium in the trachea is far common. Hypoxia triggers a reversion or persistence of intensive pulmonary arteriolar constriction, which is a normal condition in the fetus. Other causes include respiratory distress syndrome (Idiopathic respiratory distress syndrome in newborns) Early ductus arteriosus or closure of the foramen ovale (Perinatal Physiology: cardiovascular function), which can be increased fetal lung blood flow and triggered by maternal NSAIDs pulmonary hypoplasia Congenital diaphragmatic hernia (diaphragmatic hernia ), wherein a lung is severely hypoplastic, and thereby suppresses the majority of the pulmonary blood flow through the other lung. Neonatal sepsis (sepsis in newborns) or pneumonia (pneumonia in newborns) presumably because vasoconstrictive prostaglandins are produced by activation of the cyclooxygenase passage through bacterial phospholipids. Pathophysiology Regardless of the etiology of the increased pressure in the pulmonary arteries causes pathological smooth muscle development and hypertrophy of the walls of the small pulmonary arteries and Pulmonalarteriolen, a right-left shunt through the ductus arteriosus or the foramen ovale and resulting in an untreatable systemic hypoxia. Both pulmonary and systemic resistances are high, which leads to an increased workload on the heart. This stress can result in an increase in dilation in the right ventricle, a tricuspid regurgitation and a right-sided heart failure. Symptoms and signs Symptoms and signs include tachypnea, retractions and severe cyanosis or decreased oxygen saturation, which does not respond to an O2-gift, a. In infants with a right-left shunt through the patent ductus arteriosus, oxygen saturation in the right brachial artery is higher than in the aorta. Therefore, the cyanosis may look different and the O2 saturation in the lower extremities are at ? 5% than in the right upper extremity. Diagnosis cyanosis, which is refractory to O2 therapy echocardiogram radiograph to identify underlying diseases The diagnosis should be suspected in a near term infants with arterial hypoxemia, cyanosis, or both, especially when the O2 saturation by the transfer of 100% O2 does not improve. The diagnosis is confirmed by an echocardiogram showing the elevated pressures in the pulmonary arteries and simultaneously exclude a congenital heart defect. The lung fields can be normal on the chest x-ray, or they show the underlying disorder such. As a meconium aspiration syndrome [meconium aspiration syndrome], a neonatal pneumonia or congenital diaphragmatic hernia one. Prognosis The oxygenation index (mean airway pressure [cm H2O] × fraction of inspired O2 [FiO 2] × 100 / PaO 2) is used to assess the severity of disease and the intervention time (especially for inhaled nitric oxide [oxygenation index 15 to 25] and extracorporeal membrane oxygenation [ECMO oxygenation index> 40]) to determine. The overall mortality rate ranging from 10-60% and depends on the underlying cause. However, 25% of survivors develop mental retardation, hearing impairment, functional disorders or a combination. The number of faults is no different from that of other serious diseases. O2 treatment for expanding the pulmonary vasculature and improve oxygenation. Mechanical ventilation Inhaled nitric oxide if required ECMO support the cycle Treatment with O2, which is a strong pulmonary vasodilator will begin immediately to prevent progression of the disease. O2 is bags and mask or mechanical ventilation: where (A breathing assistance in neonates and infants Mechanical ventilation); the mechanical expansion of the alveoli helps vasodilation. The FiO 2 should be at the beginning of one, but can be titrated down later to get the PaO 2 between 50 and 90 mmHg and to minimize lung injury. Has the paO2 stabilized, you can try to reduce the FiO 2 in increments of 2-3%. Then slowly decreases the ventilation pressure, since large changes in PaO2 may cause a renewed vasoconstriction of the pulmonary arteries. expands a high-frequency oscillatory ventilation and ventilates the lungs, while holding the barotrauma low and should be used in infants with an underlying lung disease in which the atelectasis and the mismatch of ventilation / perfusion (V / Q) hypoxemia pulmonary by persistent worsens hypertension of the newborn. Inhaled nitric oxide may relax the endothelial, smooth muscle, dilates Lungenarteriolen, thus increasing the pulmonary circulation and improves oxygenation in more than half of the patients. The initial dose is 20 ppm and is reduced depending on the effect. ECMO (ventilatory support in newborns and infants: (extracorporeal membrane oxygenation ECMO)) can be used in patients with severe hypoxic respiratory failure, which is defined by an oxygenation index> 35-40 despite maximal ventilatory support. Normal fluid, electrolyte, glucose and calcium levels need to be maintained. The infants should be held in a neutral warm environment and treated with antibiotics for possible sepsis through until the culture results are known. Inotropes and compressors may be required as part of circulatory support. Important points Longer hypoxia or disorders that increase the pulmonary blood flow, causing smooth muscle hypertrophy in small pulmonary arteries, resulting in persistent pulmonary hypertension. Persistent pulmonary hypertension causes right-to-left shunting through the ductus arteriosus or foramen ovale, which results in a persistent systemic hypoxemia; a right-sided heart failure can develop. The diagnosis is confirmed by echocardiography. O2 for expanding the pulmonary vessels, mechanical ventilation, inhaled nitric oxide, and in severe cases ECMO be administered.

Health Life Media Team

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